Analyzes, codes, abstracts, and compiles medical records of patients of health care delivery system to document patient condition and treatment by performing the following duties: Essential Duties and Responsibilities Medical Record Coder Abstracts and codes diagnoses, operations, and procedures from health records by using appropriate classification systems, standards, and procedures. Prepares statistical reports required by applicable legal, accrediting, and/or licensing regulations and office policy. Assigns patient severity of illness index ratings, supplemental codes, and other data as necessary. Compiles information and data from health records and computer systems for use in the evaluation of quality of care and utilization review. Monitors completion of medical records in accordance with time standards. Audits incomplete records and prepares reports on delinquencies. Confers with doctors, nurses, and other health personnel to assure complete, current, and accurate medical records. Compiles and maintains logs, reports, and statistical records, and researches records to locate health data as requested. Maintains and utilizes variety of health record indexes and storage and retrieval systems. Operates computer to process, store, and retrieve health information. Assists in identification of medical records needed for research, using both manual and computer indexes. Responds to patient billing and statement inquiries. Relays financial information/policies regarding co-pays to new patients, plus policy for procedures. Assures pre-certification is obtained for treatment, lab, CT and bone marrow biopsies. Assures active coverage for insurance from the patient. Gathers benefit information by calling insurance companies to assure benefits meet guidelines. Reports to other billing employees the pertinent information and documents in computer. Inputs new patient insurance information into Mosaiq and Epic. Checks schedule for treatment pre-authorization and notifies chemo RN’s of treatment that needs specific information to complete pre-cert.
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Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
11-50 employees